Many hospitals in Germany are facing increasingly difficult financial situations. The Federal Cabinet previously approved the so-called hospital reform, seeking to place hospital care on a solid foundation for the future. The reforms aim to ensure high quality hospital treatments across the board and reduce hospital bureaucracy. After its adoption by the Bundestag, the Bundesrat approved the law, and it has now come into force.

The hospital reform had the potential to “ensure good inpatient treatment for everyone in an ageing society,” said Federal Health Minister Karl Lauterbach. Without structural changes to inpatient care, he said, there was a risk of hospital insolvencies, poor treatment for patients, and long journeys to hospitals.

What are the hospital reforms?

The goal of the Hospital Care Improvement Act is to ensure that patients’ reasonable expectations continue to be met, the Federal Health Minister said. These included “a rural hospital, a maternity ward nearby, quick access to emergency care, and outstanding quality in complicated procedures,” he said.

The key elements of the reforms:

• One of the core elements is the adaptation of the existing remuneration system of flat-rate payments per case, which would reduce the financial pressure on hospitals to take in more and more patients. Instead, hospitals are to receive the majority of their remuneration simply for the services they provide.
• In future, hospitals are to be assigned to “service groups” based on which quality criteria they meet. These criteria are to apply uniformly across the whole of Germany. The aim of allocating hospitals to service groups is to ensure in future that services are only provided where the right equipment is available and where staff are properly trained.
• The Länder will remain responsible for hospital planning. They will decide which hospital is to provide which group of services.  
• The Länder will also be able to designate certain institutions to provide services across all medical and care sectors so as to ensure the public can access high-quality basic care in their area. These facilities will offer inpatient, outpatient and nursing services.

The reform is due to come into force on 1 January 2025, with changes to be implemented in stages. The Länder will be able to assign their hospitals to service groups by the end of 2026, for instance. 

Do you have any questions on the hospital reform? See the website of the Federal Ministry of Health for answers.

The hospital reform is underpinned by the Hospital Transparency Act, which is already in force. One key instrument here is the Federal Hospital Atlas, which provides patients with greater transparency.